[The diagnosis and treatment of cholangiolithiasis after cholecystectomy]. / Diagnostika i lechenie kholangiolitiaza posle kholetsystéktomii.

Results of complex examination and treatment of 138 patients with postcholecystectomic cholangiolithiasis were analyzed. Residual cholangiolithiasis was diagnosed in 104 (75.4%), recurrent--in 34 (24.6%) patients. Differential-diagnostic symptoms of residual and recurrent cholangiolithiasis are specifiEd. Diagnostic and curative algorithm was developed, criteria of choice of curative (instrumental or surgical) methods were clarified. Mini-invasive surgeries (endoscopic papillosphincterotomy, suprapapillar choledochoduodenostomy, dissection of stenosed choledochoduodenoanastomosis, percutaneous transhepatic cholangiostomy, lithoextraction through external bile fistual, mechanical and laser lithotripsy, nasobiliar drainage) from different diapeutic approaches were performed in 137 (99.3%) patients. Diapeutic instrumental procedures were effective and final in 91.9% cases (in residual cholangiolithiasis--94.2%, in recurrent--82.4% cases). Lethality was 0.7%.

[Decompression of the biliary tract in preparation for radical surgery of patients with obstructive jaundice and cholangitis]. / Dekompressiia zhelchevyvodiashchikh putei dlia podgotovki bol'nykh s obturatsionnoi zheltukhoi i kholangitom k radikal'noi operatsii.

Rational use of mildly invasive percutaneous and endoscopic instrumental interventions for decompression of the biliary tract in patients with cicatricial and tumor strictures of the pancreaticobiliary zone rapidly arrests the manifestations of obstructive jaundice. This reduces considerably the risk of the subsequent operation. Analysis of the results of radical surgical treatment of 12 patients with posttraumatic cicatricial strictures and tumors of the biliary tract showed the advantages of two-stage tactics in the management of these patients. The use of such tactics in the clinic led to a decrease of the incidence of postoperative complications to 42.8% and was attended with a favorable outcome in all cases.

[Diagnosis and treatment of obstructive cholangitis]. / Diagnostika i lechenie obstruktivnogo kholangita.

The results of complex diagnosis and treatment in 237 patients with obstructive cholangitis are discussed. On basis of the analysis of the obtained data the therapeutic measures were undertaken in two stages: emergency endoscopic decompression of the biliary tract was carried out at the peak of the clinical manifestations, whereas final correction of the obstruction, if necessary, was performed after removal of infection in the bile ducts, complete relief of endogenic intoxication, and normalization of hepatic function. Such therapeutic tactics reduced acute cholangitis mortality to 5.5%.

[Chemical mucolysis and obliteration of the gallbladder lumen in high surgical risk patients (experimental study)]. / Khimicheskaia mukoklaziia i obliteratsiia prosveta zhelchnogo puzyria u bolnykh s vysokim operatsionnym riskom (éksperimentalnoe issledovanie).

A method for obliteration of the gallbladder, based on its mucoclasis with phenol preparations, was developed in experiments on unbred dogs. The safety of using preparations based on phenol for chemical demucosation of the gallbladder is demonstrated. The suggested method may serve as a prototype for the development of similar interventions in clinical practice in acute cholecystitis and cholelithiasis after endoscopic cholecystostomy and cholecystolithoextraction. The method was used in clinical practice in 3 patients with acute calculous cholecystitis and severe concomitant pathology and a high operative-anesthesiological risk.

[Surgical treatment of patients with cholelithiasis]. / Khirurgicheskoe lechenie bol'nykh zhelchekamennoi bolezn'iu.

The article analyses the results of treatment of 1,506 patients with cholelithiasis in the period between 1977 and 1986. On the grounds of the results four groups of risk were set apart. The lethality rate was 6.6% in the group of patient over 60 years of age. Performance of the operation in jaundice worsens the results 3.5 times, while conduction of choledochotomy in calculous cholecystitis leads to 3-4 fold increase in lethality depending on the patient's age. Diagnostic endoscopic retrograde cholangiopancreatography in patients with complicated forms of the disease helps in identifying the cause of jaundice before the operation. It is shown that the use of endoscopic papillosphincterotomy, both as the first and, in some cases, as the final stage of the treatment of the most severe patients with choledocholithiasis is promising.